Major Depression Flashcards by Natasha Martorano

How was depression first described by Hippocrates

Described as melancholia

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What were the four humors, what is their relation to disease in general and melancholia specifically ?

Four humors: yellow bile, black bile, phlegm, and blood
Disease occurred when the humors were out of balance
Melancholia was the result of too much black bile

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Who is associated with the history of classification of major depression

Emile Kraepelin

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According to Kraepelin what is the chief origin of psychiatric disease

Biological and genetic malfunction - psychological disorders as physiological entities

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According to Kraepelin, diseases were grouped together based on classification of ______, not similarity of ______

Syndromes, symptoms

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How was the unitary concept of psychosis redefined

Manic depression (includes MDD and BP)
Dementia Praecox

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Explain Kraepelin’s thoery of psychosis

Two distinct syndromes: dementia praecox and manic-depressive illness
- Dementia Praecox: rapid cognitive disintegration; disruption in attention, memory, goal-directed behaviour; eventually relabeled as schizophrenia
- Manic-depressive illness: primary mood disturbance, disruption in affective functioning, eventually split up into multiple mood disorders

Distinguishes radically different forms of functioning - still a unitary view of mood disorders

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Until when was Kraepelin’s view on classification the dominant one

Mid 1950s

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Who proposed the unipolar-bipolar distinction

Karl Leonhard

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How do we distinguish a unipolar person versus a bipolar person

Unipolar: experiences EITHER depression or mania
Bipolar: experiences BOTH depression and mania

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True or false: it is common for people to have unipolar mania

False

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How was major depressive disorder introduced into the DSM

Introduced into the DSM-II as “depressive reaction” or a response to adverse life events

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In what version of the DSM was Major Depressive Disorder introduced?

In the DSM-III

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True or false: Depressive disorders and bipolar disorders are in the same chapter in the DSM-5 but they are separated within that chapter

True

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In the DSM-5, bipolar is between ______ and ______

Depressive, schizophrenia

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What is a change that was brought about in the DSM-5 for the bipolar disorders

More specific symptomology for hypomanic and mixed manic states

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What is a change that was brought up in the DSM-5 for depressive disorders

Additional of disruptive mood dysregulation disorder - avoid giving a bipolar disorder diagnosis at a young age
Persistent Depressive disorders - formerly dysthymia
Premenstrual dysphoric disorder
Bereavement clause removed

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When would someone be diagnosed with MDD

If they have a history of depressive episodes but no mania

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How many of the depressive symptoms are needed within the same 2-week period to qualify for a diagnosis of MDD

5 or more symptoms
All must be present simultaneously during the 2 week period
Person must also report experiencing marked distress or a decrease in functioning during these 2 weeks

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What are the 2 cardinal symptoms of MDD? Do they both need to be present for a diagnosis?

Dysphoric mood - sad empty, tearful
Anhedonia - diminished interest or pleasure in all or almost all activities

Only need 1 for diagnosis

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If the person shows anhedonia and dysphoria how many other symptoms must be present? How many additional symptoms must be present if the person is exhibiting anhedonia or dysphoria

If both: 3 more symptoms
If only 1: 4 more symptoms

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What is anhedonia

Not distressed, just checked out/not interested

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What are the symptoms that are part of criterion A of MDD diagnosis

Weight loss or weight gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death; suicidal ideation or attempts

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MDD is _______ times more common than bipolar

10-20

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What is the gender distribution in bipolar VS unipolar disorders

Bipolar: roughly equal among men and women Unipolar: 2F =1M

What is the difference in course between unipolar and bipolar

Bipolar: earlier onset, more episodes, more pernicious course

What are the different forms of unipolar depression / specifiers of MDD

Recurrent depression Melancholia Atypical Chronic major depression

True or false: in melancholia, symptoms tend to cluster together

True

True or false: people with melancholia do well with ECT treatment but maybe not as well with antidepressants, they don’t respond to placebos but they respond to psychotherapy

True

True or false: there are major differences in family history of melancholia and in premorbid personality

False: no differences in both

True or false: melancholia is stable across episodes

False; 1 melancholic episode doesn’t mean the person will always be melancholic

Atypical depression characterizes about ____ of depressed patients

15%

Explain atypical depression

Earlier onset More comorbidity with anxiety disorders and personality disorders Strongly associated with specific treatment response which is the main reason for subtyping - responds preferentially to MAOIs, not tricyclics - many are treated with SSRIs; less effective but more convenient and safer

What does the tripartite model help us with

Helps us identify common and distinct factors of each disorder

What is the general lifetime prevalence of depression and how does it divide among the genders

General lifetime: 16-17% Women: 20-25% Men: 9-12%

What are the point prevalence rates of depression for men and women

Men: 3% Women: 6%

What is the prevalence of persistent depressive disorder

3-6%

True or false: rates of depression are much higher in Asia than in Europe and North America

False, they are lower

What is some of the evidence for the differing prevalence rates among racial and ethnic groups

African-Americans have lower lifetime prevalence than White Americans but the prevalence rates might be higher among Black youth than among white youth

What can we say about the evidence that we have for the prevalence rates in studies looking at First Nation groups, Asian-American groups relative to Caucasian-American/White participants

The evidence is mixed

What can we say about depression cross-culturally

The expression of depression may differ There is a more somatic presentation in Asian, Latin American and North African cultures - somatic presentation include headaches, loss of energy, sleeplessness

What are the dominant symptoms of depression across cultures

Depressed mood and sadness, problems with sleep, fatigue and loss of energy

What can we conclude about the Haroz et al., (2017) study about how depression is experienced around the world

If there are similar presentations we assume that it is the same disorder but we lack the appropriate cross-cultural/cultural specific measures

What is the typical age of onset of MDD

Teens/mid-20s

25% of the time, MDD is preceded by ________

Low-grade, chronic PDD/depression

Typically how long are the depressive episodes

5-6 months

What are some predictors of longer depressive episodes

Personality disorder Non-mood comorbid disorder

_____ of the time, episodes with be longer than 2 years

20%

What is the proportion of individuals who after a depressive episode will have another

50%

What is the proportion of people who will relapse after a depressive disorder

1/2 to 2/3

What is the average number of depressive episodes over a lifetime

4-6 episodes

What is dysthymia disorder

Persistent Depressive Disorder Very chronic course Over 10 year study, 75% recovered but the risk of relapse is high

What can we say about MDD and suicide

About 15% of people with mood disorders will commit suicide (die by suicide) - 5-6% of inpatients and 2% of outpatients Much higher than in the general population Suicide is most common in the 1st 6 months after recovery

What may be a protective factor of suicide in MDD

Profound anhedonia because of the disengagement

True or false: MDD is more common in the families of probands with MDD than in the families of probands with bipolar disorder

True

Describe the Kendler Twin Study

National twin registry in Sweden 15 000 complete twin pairs Diagnostic interview for MDD Results: - male twins: r=0.31 for MZ and 0.11 for DZ - female twins: r=0.44 for MZ and 0.16 for DZ

What have adoption studies of MDD looked at and what have they found

Adoptee as the proband Looked at rates of the disorder in biological and adopted families - also looked at adopted controls Results: - only the biological families had elevated rates of mood disorders - genetic factors playing a role

Concerning Early Adversity and MDD what does would Freud have to say about this

It has to do with the loss of a parent

What does the Parental Bonding Instrument by Parker help us with in understanding early adversity and MDD

Two dimensions of caregiving: care/nurturance and overprotection/control Depressed patients frequently report parents lower in care Less consistently reported is higher in overprotection This interaction poses a heightened risk for depression Abuse is associated with higher rates of depression

What is a potential third variable problem in explaining MDD

Genes

Explain the third variable problem of genes

Depression in parents, leads to poor parenting and then leads to depression in children OR it may be that the kids who will become depressed elicit more negative parenting BUT control for parental history of depression association in still there

What did twin studies on the gene third variable problem address

Looked at a set of twins; 1 twin was sexually abused and the other was not Results: rates of depression hire in the abused twin

In 6 moths prior to the onset of MDD, there is an increased rate of stressful life events. What proportion of women who experienced these events became depressed? What proportion of depressed women studied has experienced such an event 6 moths prior?

20% of women who experienced these events became depressed 75% of depressed women studied had experienced such an event in the 6 months prior to

What are the most powerfully stressors related to themes of loss

Loss of a loved one Loss of a job Loss of a cherished idea or goal

True or false: depressed people are more sensitive to the effects of stress but they do not generate more stress in their lives

False: they do generate more stress in their lives; particularly interpersonal stress

What is the distinction between dependent and independent stressors

Dependent: you are contributing to the environment Independent: independent of who you are and how you act in the world

How does reward and positive reinforcement contribute to understanding MDD

Depression is related to a reduction in behaviours that are positively reinforced (fewer good things happening to you) Less positive reinforcement = decline in mood Become less likely to engage in behaviours that receive positive reinforcement

What are the 3 components of Beck’s cognitive triad

Negative views about the world, the future and oneself - feed into each other and become a spiral that reinforces itself

According to Beck’s cognitive triad, what are 2 factors impacting motivation

Believe in their lack of ability to get positive reinforcement Belief that they won’t enjoy the reinforcement

What is the theory by Seligman that can help explain depression

Learned helplessness

What is s study that was done on undergrads to demonstrate learned helplessness

They were exposed to shocks that couldn’t be turned on/off and they showed the learned helplessness effect that researchers then expanded to other areas of one’s life

What are the 3 dimensions of attributions in the revision of learned helplessness and which ones contribute to depression

3 dimensions: - external VS internal; global VS specific; stable VS unstable Internal, global and stable are associated with depression

Considering that cognitive schemas are not readily accessible by self-reports, how can we get “access” to them

They are latent and activated by stress so we need experimental lab studies

What kind of cognitive biases do we see in lab studies

Memory and attentional biases - prioritize negative information

In the memory bias: SRET task, what do we expect to see for the “describe me” task

People will endorse more negative than positive words to describe themselves

True of false: in the stroop task, people should be slower to disengage between the word and the ink colour when the word of negative valence

True

What would be an easy condition of the dichotic listening task

It would be easier to listen to the story if the distracting words are neutral rather than negative or sad distraction words